Verified by Vertigo is a neurologic condition distinguished by a sensation of being off-balance or spinning, often described as dizziness. It is a particular type of dizziness—the disorienting sensation that your surroundings are moving while you are stationary. The false or distorted sensation or illusion of movement, and the resulting feeling of unsteadiness, may stem from problems with inner-ear function or it may have no easily identifiable cause.
Vertigo can be episodic or sustained. Most often, vertigo is set off by dysfunction of the vestibule, the part of the inner ear responsible for the body’s orientation in space. The vestibule perceives movement and acceleration so that the body can alter posture and maintain balance. Vertigo caused by a malfunction of the vestibule, or the vestibular nerve serving it, is known as peripheral vertigo. Far less commonly, vertigo stems from an infection, stroke, or traumatic injury to the brain; the condition is then known as central vertigo.
Because the sensation of spinning can be so distressing, disrupting everyday activities and creating much uncertainty as well as a fear of falling, vertigo is often accompanied by anxiety. Vertigo has been known to generate panic attacks. However, anxiety can also be a cause of vertigo and the symptoms of disorientation. Inasmuch as the sensation of vertigo is subjective, those who experience dizziness with no obvious cause are sometimes referred for psychiatric evaluation.
The term vertigo is often used metaphorically to describe a psychological state, often the uncertainties people may experience when they reach some high achievement or honor.
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The primary symptom of vertigo is the sensation that the environment around you is spinning, which creates the feeling of being off balance. People experiencing vertigo may feel dizzy, they may experience nausea and vomiting, and they may have balance difficulties and be unsteady on their feet. They may also experience blurred vision or uncontrollable eye movements that alter depth perception.
The symptoms of vertigo can be constant or sporadic, and episodes can last for seconds or months.
Sometimes just moving one’s head can set off a sudden sensation of spinning that lasts for hours, days, or weeks. The symptom indicates benign paroxysmal positional vertigo (BPPV), and although the sensation originates in the middle ear, it is not considered indicative of a serious disorder. BPPV is the most common form of peripheral vertigo.
Vertigo may also be accompanied by other symptoms. Headache is one, and there is a form of migraine—vestibular migraine—that is identifiable by the presence of vertigo.
About a third of people who experience vertigo have a history of motion sickness. Motion sickness, car sickness, in children is sometimes considered a risk factor for the development of vertigo.
To diagnose vertigo, a medical history is the first step. Then the healthcare provider likely conducts a quick test to determine the presence of benign paroxysmal positional vertigo (BPPV), the most common form. Known as the Dix-Hallpike maneuver, patients are asked first to turn their head 45 degrees to one side, then lie on their back. The occurrence of symptoms during this maneuver confirms the presence of BPPV.
If the Dix-Hallpike maneuver is not conclusive, the next step is usually audiometric testing of the vestibular canal and nerve, essential components of the balance system. Such hearing tests usually include the use of a highly sensitive probe delivering various sounds into the inner ear to see whether they are detected by the hair cells lining it.
Because the body’s balance is complex, detecting vertigo may include tests of the eyes, such as rotational chair testing, helpful in determining whether the dizziness is of peripheral or central origin. Seated in a mechanized chair that slowly rotates, patients wear special goggles that record their eye movements as the chair turns.
If the hearing or sensory tests suggest the symptoms may have a central origin, patients are usually referred to a neurologist for further testing.
Psychological problems are related to vertigo in a complex way. They may be both cause and consequence. Dizziness is an extremely upsetting sensation, and the symptoms are often unpredictable and inexplicable, beginning and stopping without discernible cause. Vertigo is disorienting in every sense of the term.
Numerous studies show that about 50 percent of people experiencing vertigo develop secondary, or reactive, anxiety. Up to 10 percent of people may develop panic. They fear falling, injury, even death. The everyday act of crossing a street can seem terrifying. In addition, people experiencing vertigo may begin avoiding work or social situations where a bout of dizziness could result in harm or embarrassment—reactions that wind up amplifying their distress.
Clinicians find that one antidote to anxiety and social withdrawal is information. Even when symptoms persist, patients benefit from knowing what can provoke them.
In many cases, the cause of vertigo is unknown. Vertigo usually reflects a problem in the body's vestibular system, which includes the vestibule of the inner ear, the vestibular nerve, the brain stem, and the cerebellum, a brain region that integrates sensory perception, coordination, and motor control.
Sometimes just moving one’s head—tilting it up or down, or quickly turning—can set off an episode of vertigo, usually of short duration. In such cases, the disorder is known as benign paroxysmal positional vertigo (BPPV), and it is the most common cause of vertigo.
Psychiatric disorders, most notably anxiety, can also cause vertigo. There’s some evidence that both acute and chronic anxiety can impair the integration of sensory and motor signals, giving rise to vertigo or other forms of dizziness—such psychophysiological dizziness may be alleviated by standard anti-anxiety treatments, including cognitive behavioral therapy.
The most common cause of vertigo is BPPV. The dizziness, usually of short duration, occurs when tiny deposits of calcium become temporarily trapped in the semicircular canals of the middle ear.
Another relatively common cause of vertigo is a distinctive form of migraine headache known as vestibular migraine. Unlike other forms of migraine, there may not be a pounding or throbbing headache; instead, there are symptoms of feeling off-balance originating in the vestibule, the sensory system of the inner ear, responsible for tracking body position in response to movement and maintaining balance.
Meniere’s disease, a disorder of the inner ear, is often associated with vertigo-type dizziness, which is said to be the most disabling symptom of the disorder. It can be accompanied by nausea and vomiting.
Researchers report that 30 to 50 percent of cases of chronic vertigo and dizziness are accompanied by mental disorders, most commonly anxiety, sometimes depression, and occasionally both. And while psychiatric disorders can be the cause, more often they are a consequence of vertigo. The disorder can take an emotional toll. Even though they can develop after the onset of the vestibular symptoms, secondary psychiatric disorders can outlast the symptoms of vertigo.
Medications for vertigo depend on the underlying cause. If a person suffers vertigo because of an inner ear problem or Meniere’s disease, a physician may prescribe an antihistamine such as meclizine. This antihistamine is prescribed to prevent symptoms of motion sickness like nausea, vomiting, or dizziness. Benzodiazepines like valium are also used to address the anxiety that can accompany vertigo. Other drugs may help stabilize the vestibular sensory system and maintain spatial orientation and balance. Corticosteroids are also used to alleviate inflammation, which can cause vertigo.
Health professionals—a physician or physiotherapist—might perform the Epley and Semont maneuvers that treat benign paroxysmal positional vertigo. These exercises are designed to reposition calcium crystals in the inner ear.
Additionally, there are exercises an individual can attempt to ameliorate the condition. Below are two examples:
Exercise 1: While standing with feet at shoulder width, sway back and forth by moving your weight from toe to heel. Repeat this 20 times.
Exercise 2: Fix your eyesight on something three to ten feet away. For 30 seconds, move your head from side to side, while keeping your eyesight fixed. For the next 30 seconds, move your head up and down, while keeping your eyesight fixed.
Health and lifestyle changes may also help. Avoid caffeine, alcohol, salt, and tobacco. Keep a regular sleep schedule, and try meditation and relaxation techniques for stress.
